The Use of International Classification of Functioning, Disability and Health in Analysing Qualitative Data on Childhood Blindness: A Hollistic Framework for Disability Research
Blindness in children, particularly in developing countries, has long been recognized as a major challenge for children, their families and service providers. Understanding the needs and characterizing the forms of disability faced by blind children is of paramount importance to create an inclusive, barrier-free and rights based society for children who are blind. The aim of this qualitative study was to understand the life of children who are blind in Bangladesh, with the view to inform policy makers and planners for better service delivery to address the needs of blind children and their families. This paper aims to demonstrate a process of using the ICF as a framework to code, classify and connect diverse social, environmental, biological and psychological issues and themes which emerged from a qualitative disability study. Seventy six semi-structured interviews and 15 Focus Group Discussions were conducted with children, parents and service providers in Bangladesh. Qualitative data was systematically recorded and processed to ensure that the exact verbatim is archived as primary data for further analysis. A two stage analysis process was adapted- 1) Firstly, generating themes and sub-themes and organizing them into a thematic framework, grounded in the data. 2) The 2nd level of analysis explored each theme or sub-theme and associated data with them, to identify the exact ICF domain and codes which relates well to the study themes and sub-themes. Through the first stage of analysis, the study data generated 142 basic level codes (micro-themes), which were organized under 48 sub-themes, which were organized under 10 themes of the study. The thematic framework included data on- Attitude towards blind children, Psycho-social impact of childhood blindness, on children and family; Knowledge about causes and treatment of childhood blindness, Health care seeking behavior, Barriers of access to services and current situation of health care, education and rehabilitation services for children who are visually impaired and blind Bangladesh. In the 2nd stage of analysis by using ICF, all 142 basic level codes from 1st stage were found to be associated with a code and domain of ICF. 112 basic level codes, generated from the study data, were linked with environmental factors domain in ICF, 24 with activity and participation domains, 5 with personal factors and 1 with body function or structure domain. Among the environmental domains, 74 were related to attitude (e4) of other people towards blind children, 27 with service, system and policies (e5) affecting blind children, 7 related to support and relationships (e3) and 4 related to products and technology (e1). Specific recommendations for action were made on each domain areas to improve the situation of blind children in Bangladesh.
ICF provides a useful, holistic and action oriented framework, which can be used successfully in capturing and analyzing qualitative data from disability studies on children who are blind. ICF also provides an opportunity to produce comparable data by researchers working in diverse context and a useful framework for policy makers to formulate policies and action against disability, taking disabled children and their families view as the focal point.
Keywords: ICF, Childhood Blindness, Disability, Social Model, Medical Model, Bangladesh, Child Health
Dr. Mohammad Muhit
Clinical Research Fellow, International Centre for Eye Health, London School of Hygiene & Tropical Medicine
Affiliation not supplied
Prof. Sally Hartley
Professor, Institute of Health, University of East Anglia